Liver stiffness measurement can reflect the active liver necroinflammation in population with chronic liver disease: A real-world evidence study

Abstract

Background and Aims: Non-invasive evaluation of liver nec-roinflammation in patients with chronic liver disease is an un-met need in clinical practice. The diagnostic accuracy of transient elastography-based liver stiffness measurement (LSM) for liver fibrosis could be affected by liver necroinflam-mation, the latter of which could intensify stiffness of the liver. Such results have prompted us to explore the diagnosis potential of LSM for liver inflammation. Methods: Three cross-sectional cohorts of liver biopsy-proven chronic liver disease patients were enrolled, including 1417 chronic hepatitis B (CHB) patients from 10 different medical centers, 106 non-al-coholic steatohepatitis patients, and 143 patients with auto-immune-related liver diseases. Another longitudinal cohort of 14 entecavir treatment patients was also included. The re-ceiver operating characteristic (ROC) curve was employed to explore the diagnostic value of LSM. Results: In CHB patients, LSM value ascended with the increased severity of liver nec-roinflammation in patients with the same fibrosis stage. Such positive correlation between LSM and liver necroinflammation was also found in non-alcoholic steatohepatitis and autoim-mune-related liver diseases populations. Furthermore, the ROC curve exhibited that LSM could identify moderate and se-vere inflammation in CHB patients (area under the ROC curve as 0.779 and 0.838) and in non-alcoholic steatohepatitis patients (area under the ROC curve as 0.826 and 0.871), respec-tively. Such moderate diagnostic value was also found in autoimmune-related liver diseases patients. In addition, in the longitudinal entecavir treated CHB cohort, a decline of LSM values was observed in parallel with the control of inflam-matory activity in liver. Conclusions: Our study implicates a diagnostic potential of LSM to evaluate the severity of liver necroinflammation in chronic liver disease patients. Citation of this article: Wang L, Zhu M, Cao L, Yao M, Lu Y, Wen X, et al. Liver stiffness measurement can reflect the active liver necroinflammation in population with chronic liver dis-ease: A real-world evidence study. J Clin Transl Hepatol 2019;7(4):313–321. doi: 10.14218/JCTH.2019.00040.